From Core Values to Cost Savings
A look at how MedOne cut pharmacy spend in half for Midwest manufacturer. Below is an overview, followed by an explanation of how MedOne successfully overcame the challenges.
Introduction
Gamber-Johnson, a leading manufacturer of rugged mounting systems, faced significant challenges managing and controlling their pharmacy spend. Rising specialty drug costs, inflexible programs, and limited collaboration with their pharmacy benefit manager (PBM) were driving up expenses while frustrating their team and members.
They turned to their broker partner M3 Insurance, a Midwest-based top insurance broker and risk management firm in search of a solution. At the recommendation of their M3 representative, Gamber-Johnson partnered with MedOne—a full-service pharmacy benefit manager focused on transparency, innovation, and actionable cost containment strategies. This partnership not only met but exceeded expectations, delivering substantial cost savings, improved member outcomes, and unparalleled customer service.
Since making the move to MedOne, Gamber-Johnson was named the #1 Healthiest Workplace in Wisconsin and the #15 in the United States according to Healthiest Employers®, in partnership with Springbuk.
Before transitioning to MedOne, Gamber-Johnson encountered numerous roadblocks that hindered cost management and member satisfaction. These included: 1) formulary misalignment, 2) inflexibility and lack of innovation, and 3) high specialty drug costs. Phillip Blair, the vice president of human resources at Gamber-Johnson, noticed these patterns in the claims data and grew frustrated with the lack of actionable solutions.
Formulary Misalignment
For Gamber-Johnson, the previous PBM’s approach to formulary management often favored more expensive products, resulting in unnecessary spending.
“When we ran into some with the change in formulary… we would take a look at what the preferred medication with MedOne was versus the preferred medication with [the previous PBM], and they obviously had different methodologies,” said Blair.
Gamber-Johnson found that, when comparing the formularies of MedOne and their previous PBM, the previous PBM’s formulary contained higher-cost medications, often accompanied by high rebates. Based on the traditional model on which the previous PBM operated, these rebates were then retained by that PBM whereas with MedOne’s pass-through model, those rebates would have been routed to Gamber-Johnson. Not only was Gamber-Johnson paying more for on-formulary drugs, they were not awarded the rebates they earned, based on their utilization.
High Specialty Drug Costs
Specialty medications are a rapidly growing category of spend, driving overall prescription spend upwards. The presence of specialty drugs in a claims file is not an issue on its own; the high costs often associated with them, however, is where issues arise. Gamber-Johnson’s utilization featured a handful of specialty claims that were burdening the plan.
When Gamber-Johnson met with MedOne, it became clear that MedOne’s approach aligned seamlessly with their goals. MedOne’s pass-through and fully-transparent model, combined with a focus on proprietary and actional cost containment strategies, appealed to Gamber-Johnson’s objectives.
Mindy Peterson, a business insurance associate at M3 and lead point of contact for Gamber-Johnson, described MedOne as “proactive, transparent, and member-centered.” Administering a pharmacy benefit is more than dollars and cents. She spoke about her decision to bring MedOne into the conversation: “Knowing what Phil wanted to do and what the future strategy looked like, the core values really aligned; it was a great fit.”
When MedOne speaks about alignment, the conversation goes beyond the world of pharmacy spend. True alignment goes deeper, into the mission, vision, and values of an organization. MedOne for example believes in helping people access the most appropriate prescription at the most affordable price, and core values include 1) prioritizing the well-being of employees, 2) striving to exceed client expectations, and 3) creating and embracing positive change. Pairing up with Gamber-Johnson, the synergy is obvious.
The guiding principles at Gamber-Johnson speak to the importance of generating “joyful growth.” This concept prioritizes the people at the heart of Gamber-Johnson alongside the importance they place on innovative products and operating under impeccable standards. This shared vision spoke to both the M3 and Gamber-Johnson teams, and ultimately invited MedOne to the table.
MedOne met with Gamber-Johnson in the fall of 2023 to discuss a new pharmacy benefit strategy. After sharing about MedOne’s roots in pharmacy and their unique approach to the marketplace, the conversation turned to the pain points Blair and his team were experiencing with the incumbent PBM. This initial touchpoint hammered out the cost-containment & access strategies MedOne would later implement for Gamber-Johnson, outlining MedOne’s depth and expertise. Blair recalled: “The level of conversation was way more than any conversation we had with the previous PBM… We walked out of that meeting and said, ‘Yes, we can move forward.’”
MedOne’s customer service stood out from the start. Gamber-Johnson’s account is serviced by Chief Pharmacy Officer Dr. Nathan Harold, Director of Account Management Danielle Barton, and Senior Account Manager Whitley Johll. This three-pronged service approach ensures MedOne clients have access to the resources and expertise they need around the clock. Early in the relationship, Blair recalled that “Danielle and Whitley were phenomenal. They answered every question I had really, really quickly.“
MedOne’s commitment to transparency and proactive service has been key to Gamber-Johnson’s success. MedOne regularly dialogues with both the Gamber-Johnson and the M3 teams sharing insight on up-and-coming industry trends, legislation changes, new cost-saving programs or opportunities, and other relevant topics.
“We’re talking to the MedOne team all the time. When member issues pop up, whether we need to switch drugs or whatever the case may be, it is a partnership.”
At the core, it is about making sure that the member is taken care of versus what kickbacks they’re going to get at the end of the day,”
said Peterson.
For example, a new Gamber-Johnson employee approached Blair expressing an interest in enrolling in the Gamber-Johnson plan but also a concern about a costly medication the employee was on. Blair relayed this information to MedOne to see how the prescription would be handled on the plan.
MedOne ran some test claims and relayed their findings to the Gamber-Johnson team. Per the plan design, the medication in question would not be covered but MedOne provides some additional options the member could explore to obtain their medication. The ensuing conversation was an overall positive one, due to MedOne’s transparent and proactive approach. The member ultimately made the decision to stay on the spouse’s plan. “A new hire hearing their medication was not going to be covered has the potential to be a really hard conversation. We gave them so much information and several different routes they could go down if they were to come to us, and they were happy.”
Consistent and thorough collaboration is key in these situations, and MedOne ensures frequent touchpoints to address questions and provide solutions.
Financial Alignment
MedOne focuses on driving to the lowest net cost for both the plan and the member while maintaining a high standard of care. A large sticking point with the previous PBM revolved around formulary structure and their capture of rebates.
This misalignment in formulary structure can be explained by looking at blood glucose monitoring systems for diabetics. These systems are often viewed as a black-and-white example in pharmacy; the system is either reading the levels and providing an accurate result or not.
The previously preferred monitoring device was a brand-name system costing between $8,252.20-$8,832.20 annually. As this was the preferred system on the previous plan, this drove costs for both the Gamber-Johnson plans and members up, compared to more affordable alternatives like MedOne’s preferred option.
In this apples-to-apples comparison, MedOne’s preferred system is 2-3 times less than the previous PBM’s. Even with just a small number of claimants utilizing a blood-glucose monitor, the switch to MedOne’s preferred monitor would result in significant savings. The next step was simply to notify members of the upcoming change.
Diabetic members of the Gamber-Johnson prescription health plan were alerted via letter that the new plan, effective January 1, 2024, included a different preferred monitoring system. Disruption is to be expected when making any sort of plan change. It was the proactive communication that ensured a smooth transition of the members to the new device.
“Despite having a pretty drastic change from our previous PBM with a very large formulary – and we still have a very large formulary today – I think we have gotten equal if not better reviews with MedOne,” said Blair.
Innovative Programs
“When meeting with MedOne, what stood out to me was the fact that MedOne has so many of the levers, if not all of the levers, available within their existing structure. We didn’t have to go out and piecemeal all these different things to make an ultimate, better benefit for our team members.”
MedOne’s specialty cost containment strategies delivered dramatic savings for Gamber-Johnson upon implementation. Major pain points with the previous PBM centered on a small number of specialty claims. Knowing this, MedOne encouraged Gamber-Johnson to enroll in MedOne’s RxAlly program, their proprietary suite of specialty cost containment solutions.
While reviewing the claims experience, MedOne’s team of Patient Care Coordinators identified which of the strategies would result in the most savings for Gamber-Johnson and their members.
A handful of members were identified. One of the claims was for a medically necessary brand-name medication for Crohn’s disease. MedOne identified this prescription would be more affordable for both the plan and the member when sourced internationally.
Per the plan’s PPO plan, this member is able to access the medication at a $0 copay. Despite there being no member cost share, the plan still comes out ahead and still captures the rebate per MedOne’s pass-through model. Overall, by leveraging MedOne’s network of international pharmacies, the plan is saving almost $84,000 annually, on this one member alone.
The use of these targeted strategies and upfront communication was the key to such a significant decrease in overall pharmacy spend for the plan.
Since entering into the partnership with MedOne, Gamber-Johnson has experienced the following savings:
Annual pharmacy spend prior to moving to MedOne was roughly $326,000. It is now in the ballpark $222,000. This moves the per-member-per-month (PMPM) costs from $103 PMPM to $46 PMPM.
It’s important to note, too, that these savings are in spite of an uptick in member count; Membership increased from 264 to 384 members during the first year of the service agreement with MedOne, yet total spend still dropped by over $100,000.
At the end of 2024, Gamber-Johnson spent:
MedOne’s proactive management and innovative solutions ensured members received the medications they needed while identifying opportunities for cost savings.
Blair and his team experienced open, ongoing communication with MedOne, ensuring alignment on benefit strategies and rapid resolution of issues. “Everything is answered within 24 hours. I have all the information I need,” said Blair.
Conclusion
MedOne’s partnership with Gamber-Johnson exemplifies the value of a proactive, aligned transparent, and flexible PBM. By aligning on core values and implementing strategies tailored to Gamber-Johnson’s needs, MedOne delivers a significant net cost reduction, improved health outcomes, and a level of service unmatched in the industry.
Gamber-Johnson’s success demonstrates that MedOne is more than just a PBM—it is a strategic, key partner in achieving sustainable, member-centered pharmacy benefit solutions.